Election Of Joint And Survivor Benefit Upon Retirement Form
Download a blank fillable Election Of Joint And Survivor Benefit Upon Retirement Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Election Of Joint And Survivor Benefit Upon Retirement Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Teamsters Joint Council No. 83 of Virginia
Health & Welfare and Pension Funds
8814 Fargo Road ∙ Suite 200 ∙ Richmond, VA 23229
Phone (804) 282-3131 ∙ 800-852-0806 ∙ Fax (804) 288-3530
Election of Joint and Survivor Benefit Upon Retirement
You have a right to take 30 days to consider the form of benefit.
Retiree's name ________________________________________
SSN ________________________
Spouse’s name ________________________________________
SSN ________________________
Spouse's date of birth______________________
I ELECT TO HAVE MY SPOUSE RECEIVE 50%_______ or 66.7%______ or 75% ______or 100%______ OF
MY PENSION BENEFITS IN THE EVENT OF MY DEATH. (Check one %)
I UNDERSTAND THE FOLLOWING CONDITIONS:
1) If I elect the Joint and Survivor Benefit, my pension benefits will be reduced on the basis of actuarial
equivalence using my age and my spouse’s age at my retirement in order to provide the lifetime benefit to my
spouse after my death.
2) My election of the Joint and Survivor Benefit cannot be cancelled or changed once I retire under this benefit
except as noted below.
3) My spouse and I must be legally married to each other when my pension benefits begin for the Joint and
Survivor Benefit to be effective.
4) If my spouse dies before my pension benefits begin, this election is cancelled and no reduction will be
made in my pension benefits for the Joint and Survivor Benefit. If my spouse dies after my pension benefits
begin, I will continue to receive the reduced pension benefits until the month after I submit a certified copy of
my spouse's death certificate to the Fund Office.
5) If I am divorced before my pension benefits begin, this election is cancelled unless a Qualified Domestic
Relations Order states otherwise.
6) If I am divorced after my pension benefits begin, the Joint and Survivor Benefit remains in effect unless my
former spouse specifically waives his/her right to this benefit in a certified court order. I will continue to receive
the reduced benefit amount until I submit the certified order to the Fund Office. In the event the benefit is not
waived, my former spouse will receive the survivor benefit after my death for his/her lifetime.
Signature_____________________________________________________ Date ________________
SUBMIT COPIES OF YOUR MARRIAGE CERTIFICATE AND SPOUSE'S BIRTH CERTIFICATE WITH THIS
ELECTION.
Sept. 2010
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 5625 - Employee Benefit Plan Joint And Survivor (worksheet Number 3 - Determination Of Qualification )
Financial
Form 2 - Spouse's Waiver Of 60% Lifetime Survivor Benefit And/or Beneficiary Rights From A Pension Plan Or Annuity After Payments Start
Legal
Related Categories
Parent category: Legal